The increased presence of medical AI in clinical use raises the ethical question which standard of explainability is required for an acceptable and responsible implementation of AI-based applications in medical contexts. In this paper, we elaborate on the emerging debate surrounding the standards of explainability for medical AI. For this, we first distinguish several goods explainability is usually considered to contribute to the use of AI in general, and medical AI in specific. Second, we propose to understand the value of (...) explainability relative to other available norms of explainable decision-making. Third, in pointing out that we usually accept heuristics and uses of bounded rationality for medical decision-making by physicians, we argue that the explainability of medical decisions should not be measured against an idealized diagnostic process, but according to practical considerations. We conclude, fourth, to resolve the issue of explainability-standards by relocating the issue to the AI’s certifiability and interpretability. (shrink)

: Although philosophers often focus on the essays of Leopold's Sand County Almanac, especially "The Land Ethic," there is also a normative argument present in the stories that comprise most of the book. In fact the shack stories may be more persuasive, with a subtlety and complexity not available in his prose piece. This paper develops a narrative ethics methodology gleaned from rhetoric theory, and current interest in narrative ethics among literary theorists, in order to discern the normative underpinnings of (...) the stories in Part 1. The narrative ethics approach sidesteps the need to ground the land ethic in ethical theory—which has been a reconstructive and problematic task for the philosophical interpreters of Leopold—and suggests, instead, that it emerges in Leopold's very effort to narrate his, professional, personal, and practical experience with nature. The involves examining the stories in terms of their emotional, logical and performative aspects. The result is an analysis that shows not only how these stories express normative claims, but also justify them. One conclusion of the analyses is that, in the narratives, there is less emphasis on the problematic notion of an over-arching "community" than in the prose pieces, and more emphasis on the metaphor of other living things as "fellow travelers" in the "odyssey of evolution." Second, the narratives take on an ironic attitude toward the ecological order, less discernable in the prose essays. The order itself may not be ethically admirable, but should be preserved since it makes possible any ethical relations within it. Thus, the narrative reading suggests some temperance to the usual holistic interpretation of his land ethic and its concomitant criticisms especially the charge of ecofacism. We should not take the land ethic imperative at its face value, in the sense that the good of the order itself is an intrinsic good. In the narratives, individuals are shown not merely to be means to the ecological whole, but the focus of sympathy and concern, in a manner that demands their good should also be an object of moral consideration. (shrink)

Evidence-based medicine has always required integration of patient values with ‘best’ clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored.

Nurse philosopher Sally Gadow (1999) has proposed the relational narrative between patient and nurse as a ‘postmodern turn’ for nursing ethics. She has conceptualized this moral approach as the construction by patient and nurse of a coauthored narrative describing the good they are seeking, as well as the means to achieve this good. The purpose of this article is to provide an elaboration of Gadow's seminal conceptualization of relational narrative based on her writings and those of other philosophers. The article (...) will further develop relational narrative's foundations in relationship and narrative and will explore engagement as a dimension essential to its creation and growth. The elaboration first builds on the notion of relationship as foundational to this postmodern moral perspective. Narrative then is advanced as being at the heart of the patient–nurse relationship and their relational narrative, based on an exploration of narrative's role in the moral realm as an epistemology for patient and nurse. Finally, the dialogic and embodied engagement expressed by a relational narrative is developed as a critical element of the ethic. (shrink)

Although philosophers often focus on the essays of Leopold's Sand County Almanac, especially "The Land Ethic," there is also a normative argument present in the stories that comprise most of the book. In fact the shack stories may be more persuasive, with a subtlety and complexity not available in his prose piece. This paper develops a narrative ethics methodology gleaned from rhetoric theory, and current interest in narrative ethics among literary theorists, in order to discern the normative underpinnings of the (...) stories in Part 1. The narrative ethics approach sidesteps the need to ground the land ethic in ethical theory—which has been a reconstructive and problematic task for the philosophical interpreters of Leopold—and suggests, instead, that it emerges in Leopold's very effort to narrate his, professional, personal, and practical experience with nature. The involves examining the stories in terms of their emotional, logical and performative aspects. The result is an analysis that shows not only how these stories express normative claims, but also justify them. One conclusion of the analyses is that, in the narratives, there is less emphasis on the problematic notion of an over-arching "community" than in the prose pieces, and more emphasis on the metaphor of other living things as "fellow travelers" in the "odyssey of evolution." Second, the narratives take on an ironic attitude toward the ecological order, less discernable in the prose essays. The order itself may not be ethically admirable, but should be preserved since it makes possible any ethical relations within it. Thus, the narrative reading suggests some temperance to the usual holistic interpretation of his land ethic and its concomitant criticisms especially the charge of ecofacism. We should not take the land ethic imperative at its face value, in the sense that the good of the order itself is an intrinsic good. In the narratives, individuals are shown not merely to be means to the ecological whole, but the focus of sympathy and concern, in a manner that demands their good should also be an object of moral consideration. (shrink)

Hypothetical trolley problems are widely used to elicit moral intuitions, which are employed in the development of moral theory and the psychological study of moral judgments. The scenarios used are outlandish, and some philosophers and psychologists have questioned whether the judgments made in such unrealistic and unfamiliar scenarios are a reliable basis for theory-building. We present two experiments that investigate whether differences in moral judgment due to the role of the agent, previously found in a standard trolley scenario, persist when (...) the structure of the problem is transplanted to a more familiar context. Our first experiment compares judgments in hypothetical scenarios; our second experiment operationalizes some of those scenarios in the laboratory, allowing us to observe judgments about decisions that are really being made. In the hypothetical experiment, we found that the role effect reversed in our more familiar context, both in judgments about what the actor ought to do and in judgments about the moral rightness of the action. However, in our laboratory experiment, the effects reversed back or disappeared. Among judgments of what the actor ought to do, we found the same role effect as in the standard hypothetical trolley scenario, but the effect of role on moral judgments disappeared. (shrink)

This essay uses Solzhenitsyn’s Cancer Ward to explore the exilic effects of illness and pain. The novel is uniquely suited for such an analysis given the theme of exile that predominates both in the narrative and in the composition of multiple characters within that narrative. I argue that illness, and in particular pain, is a liminal state, an existential hinterlands. The ethical approach to literature and medicine may suggest, as a response to these exilic effects, the need to cultivate connection (...) and empathy by sharpening the moral imagination. If pain and illness exile the sufferer, the imperative to reach out takes on ethical content. (shrink)

The art of medicine stimulates the attitude of mind which concedes that on certain issues the patient knows what is right for him or her, and the public senses what is best for it. Not because they are right, but because on these issues there is no absolute right. —Anthony MooreThe benefits of fine literature, narrative analysis, and the listening to and telling of stories in education are well known (Carson 2001; Guillemin and Gillam 2006; Hunter 1996; Moore 1978; Nussbaum (...) 1990). Literature must not be overlooked in the planning or the delivery of health education and care. Narrative opens readers’ minds by promoting a plethora of viewpoints about stories and life. Through the facilitation of student-centred activities students can critically mull over central points of the story. In discerning meaning, conversations between students are generated around the crucial question, “Whose story is it?” Coincidentally this question drives, or ought to drive, medical integrity.Practitioners m. (shrink)

The interests of a patient are not only related to objective ideas about health, but are also determined by the patient’s own view of the good. To act in the best interests of a patient requires co...

In the Proceedings that emerged from the Second International Workshop on the Assessment of Animal Welfare at Farm and Group Level, Sandoe, Christiansen, & Appleby challenged participants to ponder four fundamental questions:a. What is the baseline standard for morally acceptable animal welfare?b. What is a good animal life?c. What farming purposes are legitimate?d. What kinds of compromises are acceptable in a less-than-perfect world?Continued reflection on those questions warrants examination of the shape of our modern agricultural ethic. It also calls for (...) a reexamination of recent work by Nussbaum on extending the capabilities approach to animals and the interface of Nussbaum's work with Rollin's scholarship on telos . The resources of narrative ethics are summoned to navigate the above-mentioned questions and to explore how Nussbaum's approach and Rollin's notion of animals' natures relate to the main storyline associated with developments in agriculture. (shrink)